Feeding peanut to young infants with heightened allergy risk reduces the odds that a peanut allergy will develop by a remarkable 70 to 80 percent, according to findings in the landmark LEAP study, which were revealed at the AAAAI conference in Houston on Feb. 23.

This marks a huge breakthrough in the understanding of peanut allergy prevention, and top experts were immediately contemplating actionable steps for doctors and parents.

“We believe the results from this trial are so compelling, and the problem of the increasing prevalence of peanut allergy so alarming that new guidelines should be forthcoming very soon,” wrote Dr. Hugh Sampson, director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, and a colleague in an editorial that accompanied the study’s publication in The New England Journal of Medicine.

The British LEAP (Learning Early About Peanut Allergy) study involved 640 “high-risk” babies – defined as those with egg allergy, severe eczema, or both. The infants were assigned to two groups: those whose parents were to regularly feed them peanut and those whose parents were told to have their children avoid peanut altogether. The children, enrolled between the ages of four and 11 months, were given a conclusive peanut food challenge at age 5.

At that age, on average, only 3.2 percent of the “consumption” group had developed a peanut allergy, compared to more than 17.2 percent in the “avoidance” group. (The rate of peanut allergy in the general population is 2 percent, but the babies in the LEAP study were at a higher risk for allergy.)

“There appears to be a narrow window of opportunity to prevent peanut allergy,” said study author Dr. Gideon Lack, professor of pediatric allergy at King’s College London. “As soon as infants develop the first signs of eczema or egg allergy in the first months of life, they should receive skin testing to peanut and then eat peanut products either at home if the test is negative or first under clinical supervision if the test if positive. Infants without such symptoms should be fed peanut products from four months of life.”

(His conclusions were given for physicians; it’s important not to try such steps in a baby with a genetic risk of peanut allergy without first seeing an allergist for advice and testing.)

In the study, peanut protein was usually given in the form of Bamba, a snack food made from peanut butter and puffed corn. For babies not yet able to eat solid foods, Bamba was mashed and mixed with milk or banana. Infants who did not like the snack food ate smooth peanut butter instead.

“This is a doable intervention,” study co-author Dr. George Du Toit, pediatrician and lecturer at King’s College London told Allergic Living. “It’s not like we’re offering a drug that has side effects that people don’t like taking. The kids enjoyed eating this.” He adds that many of the children ended up eating more than the required 6 grams of peanut protein per week.

There were actually two sets of children studied who either consumed or avoided peanut. In the first, 542 babies had negative results to peanut on a skin-prick testing. Even as young infants, a second set of 98 tested as mildly sensitized to peanut. Results from these distinct sets were averaged to arrive at 17.2 percent of allergy found in the avoidance group and the 3.2 percent in the consumption group are averages from these two sets of children.

But the raw data on the two sets is also compelling. In the first (542 babies, negative skin tests), 13.7 percent of the “avoidance” group developed peanut allergy compared to 1.9 percent in the “consumption” group who did not. In the second (98 babies, mildly sensitized), 35.3 percent in the avoidance group became peanut allergic by age 5, compared to 10.6 percent in the avoidance group.

“Early consumption is effective not only in high-risk infants who show no sensitivity to peanuts early on, but it is also effective in infants who already demonstrate peanut sensitivity,” said Du Toit.

Key statistics from the study:

Involved 640 infants, enrolled when they were between 4-11 months and followed until the age of 5.

Children in the “consumption” group were asked to eat 2 grams of peanut protein, equal to a heaping teaspoon of peanut butter or two-thirds of a packet of Bamba, three times a week (6 grams total).

Among the children who originally tested negative for peanut allergy, 13.7% of the “avoidance” group developed peanut allergy by age 5, compared to only 3.2% of the children who ate peanut regularly from an early age.

35.3% of the children with positive skin-prick tests (indicating a mild sensitization) who avoided peanuts developed peanut allergy, compared to 10.6% in the sensitized “consumption” group.

Early consumption of peanut reduced the risk of peanut allergy by 86% for children with negative skin prick tests.

For mildly sensitized infants, eating peanut regularly from an early age reduced the risk of peanut allergy by 70%.

The American Academy of Pediatrics (AAP) had recommended back in 2000 that children at risk for developing peanut allergy avoid peanuts altogether. However, these guidelines were withdrawn in 2008 as studies began to show that, despite avoidance, the rates of peanut allergy continued to rapidly increase. The LEAP study provides the first comprehensive data clearly showing that early introduction can protect against peanut allergy.

“This study will likely have a significant impact on approaches to prevent the development of peanut allergy in future generations,” said Dr. James Baker, president and CEO of FARE (Food Allergy Research and Education), which co-funded the study along with the National Institute of Allergy and Infectious Disease. “It is also important to note that this study was conducted as a formal, controlled clinical trial, with a well-defined infant cohort to give a definitive answer on the role of early food avoidance in the prevention of peanut allergy,” he says.

The study is continuing with the LEAP-On (Persistence of Oral Tolerance to Peanut) study, investigating whether the participants who consumed peanut will continue to remain protected against peanut allergy even if they stop eating peanuts. Researchers also hope to expand the idea of early introduction and investigate whether or not it makes a difference in the development of other prominent allergies, such as milk and egg.

Newer article – Inside the Cumin Product Recalls – is here.
The following was posted Jan. 22, 2015 and last updated February 18.

WHAT started as a single company recalling spice products due to the undeclared presence of peanut in cumin has snowballed into the most widespread series of allergy-related recalls since the U.S. Food Allergen Labeling and Consumer Protection Act (FALCPA) came into effect in 2006.

Hundreds of products produced by dozens of companies are affected, so it’s essential for those dealing with peanut allergies to become aware of the situation and to check to see whether products they purchased are among the recalls (see links below).

Aside from spice mixes, hummus and even bread crumbs, the USDA tells Allergic Living that more than 500,000 pounds of seasoned beef, poultry and pork products have been pulled off the market. A single Pennsylvania company recalled more than 35,000 pounds of its chili products. Another company recalled more than 500 of its spice products from shelves nationwide. The common culprit ingredient in all cases is the peanut-contaminated cumin.

This blitz of peanut-related recalls began* at the end of 2014 when Adams Flavors, Foods and Ingredients, a Texas company, issued a voluntary recall for several of its spice products after being notified by one of its suppliers that the cumin it purchased contained undeclared peanut proteins. (*Feb. 13 update: Allergic Living has received clarification that these recalls technically began with a Reily Foods recall in December for both peanut and almond spice contamination, but the Adams recall was the first of the numerous peanut-only ones.)

Since then, a huge number of cumin-related recalls have been issued by several companies, both in the Texas area and nationwide. From the beginning of 2015, the number of companies issuing tainted cumin-related recalls has expanded into the double-digits, and continues to rise; a trickle-down effect as news of the potential contamination makes its way through the supply chain.

“We were notified by our supplier, after theirs notified them,” says Jim English, president of Campos Foods in Tennessee, a company that recalled 5,300 pounds of chicken products due to peanut-contaminated cumin. At the time of this article, his company was in the process of sorting out the total cost involved but, for several companies, the recall losses will be huge.

English believes the only way to prevent similar occurrences in the future is greatly increased awareness on all levels of the food supply chain.

Meanwhile, the Canadian Food Inspection Agency has so far recalled one product because of the same issue – Morningstar Farms black bean burgers. CFIA told Allergic Livingthat it continues to monitor the contaminated cumin situation. If you are in Canada, check the CFIA’s recalls page for the most up-to-date information.

(Three Canadian brands also recalled similar products in fall 2014 for peanut and almond contamination: taco seasoning, taco sauce and curry powder – all very likely to contain cumin. Despite the similarity, CFIA says that, at this point, there has not been any link established to the current U.S. situation.)

The massive series of recalls across the U.S. is a source of anxiety and great concern to anyone managing a peanut allergy. The following questions and answers are designed to help address reader questions and concerns.

Do all of the recalled cumin and cumin-containing spices come from the same source?

Not all, but some. Several were tied directly to the Adams Flavors recall, but the USDA told Allergic Living that they do not all stem from the same supplier. However, many of the recalled products do seem to follow a pattern of being sold towards the end of 2014 or in early 2015.

How did the contamination occur?

[See our updated article here.] It’s not known for certain yet, but in at least some cases it appears to have happened overseas, during handling and processing in the product’s originating country. An FDA spokesperson told Allergic Living that its investigation into the case is continuing, so expect more details to become available.

Have there been any fatal allergic reactions?

Thankfully, there have been no deaths. For news related to reports of allergic reactions to these products, see our updated article here. If you or an allergic family member may have had a reaction to a food that likely contained cumin, it is important that you report it to your local FDA Consumer Complaint Coordinator.

I have a peanut allergy. Should I avoid cumin and products seasoned with it for the foreseeable future?

This is a personal choice. You could contact the manufacturer of a suspect food to check whether it or any of its suppliers were included in one of the recalls. However, representatives of both the FDA and USDA told Allergic Living thatit’s likely even more products will be recalled in the near future due to peanut-contaminated cumin.

Important Note: It’s also most important to take into consideration that, under U.S. labeling rules, individual spices don’t have to be declared, so just because a product’s ingredients list doesn’t specifically mention “cumin”, it doesn’t mean cumin isn’t present. It may be hidden behind words like “spices” or “flavor”. In addition, cumin is part of many spice blends such as chili powder and curry, making its presence possible in a very wide variety of foods.

Consumers with peanut allergy who are concerned about the recalls should exercise caution and be aware that cumin is likely to be present in Tex-Mex and Indian foods.

For more details on products affected by the recalls, including lot numbers and label photos, see the chart below. For the latest information, be sure to check the official FDA and USDA recalls pages.

*These are part of an earlier recall for peanut and almond contamination in cumin spice. One official said it does not appear to be part of the same series of cumin recalls, but be aware of those recalled items too.

“Millions across the nation have made gluten-free diets a lifestyle change,” the organization’s chief communications executive Kelly Parisi told Allergic Living. “Girl Scouts recognizes there are people avoiding gluten for various reasons, and we wanted to assure that all customers could enjoy our delicious cookies.”

Celiac disease affects approximately 1 out of 133 Americans, making a gluten-free diet a medical necessity, but millions of others have gone gluten-free by choice. A 2013 survey estimates that nearly 1 in 3 Americans claimed they cut down on or completely eliminate gluten from their diet.

With this growing demand, Girl Scouts last year experimented with selling a gluten-free chocolate chip shortbread cookie. Since that proved successful, this year the organization is introducing the certified gluten-free “Trios” and “Toffee-tastic” varieties, which will be sold nationwide (though availability may vary based on location).

The two gluten-free treats complete a lineup of a dozen different cookies being sold by nearly 1.5 million Girl Scouts across the U.S. this spring – a practice that raised nearly $800 million for Girl Scout troops and their activities last year.

“The response to our new cookies has been overwhelmingly positive, with press and cookie customers already picking out their newest favorite,” said Parisi.

Due to the increased demand for gluten-free products, this sector has experienced rapid growth. By 2016, sales of gluten-free products, such as the new Girl Scout cookies, are expected to exceed $15 billion.

Both ABC Bakers and Little Brownie Baker manufacturing company also provide allergen information on their ingredients list, making it clear if products contain any of the Top 8 allergens, as well as “may contain” warnings for cookies that share equipment with other allergen-containing products.

“If the allergen in concern is not listed below the ingredient statement, we are confident that the product is safe for consumption,” stated Little Brownie Bakers on their website. ABC Bakers, which makes the “Trios” cookie, states that they worked with multiple food organizations to ensure that their manufacturing procedures and labeling lead to safe treats for those with food allergies. With such practices, Thanks-A-Lots, Lemonades, and the classic Thin Mints are able to be free of dairy, eggs, peanuts and tree nuts.

In Canada, the Girl Guides organization does not currently have a gluten-free cookie option. However, all of their cookies – the chocolatey mints sold in the fall and the classic vanilla or chocolate cookies sold in the spring –are made by Dare Foods Limited in a dedicated nut- and peanut-free facility.

Girl Scout cookies will be sold door-to-door, at booths in public places and online through a new digital platform from January to April this year, though specific dates vary based on location.

For more information on the gluten-free and other Girl Scout cookies, see these links:

The subject of oats and the gluten-free diet can be confusing. Here’s what you need to know.

Anyone with celiac disease quickly learns that the protein gluten is found in wheat, barley, rye – and a whole host of foods, not just cereal-based ones, but packaged products such as malt vinegar, pre-made burgers (as a filler) and soya sauce. But one food that is at least getting a second chance on the gluten-free diet is Avena sativa – the common oat.

Oats do not inherently contain gluten protein, yet they are usually listed next to wheat, barley and rye as cereal grains to be avoided on the strict gluten-free diet. Why is this? The issue has been that oats in the field are commonly grown alongside or in rotation with the gluten-containing grains. It’s easy to get cross-contact during growing and harvesting, as well as through transportation on railway grain cars.

For these reasons, it’s accepted by experts that “regular” oats are likely to contain gluten and should be strictly avoided by those with celiac disease.

But fortunately, “regular” oats are no longer the only oats available. In recent years, it has become possible to purchase uncontaminated oats and, in the U.S., consumers can now find certified gluten-free oats and oat products. In other words, some manufacturers are now going the distance to ensure the oats remain “pure” and don’t get exposed to gluten.

There have been many scientific studies looking at these pure oats and celiac disease. Two recent studies - one focused on introducing oats to the diets of children with celiac disease and the other on the long-term effects of oat consumption in adults with celiac disease – found no harmful effects related to including moderate amounts of pure, uncontaminated oats in the gluten- free diet.

The Academy of Nutrition and Dietetics, the national dietitians’ organization, has released a position statement on oats confirming that the majority of those with celiac can eat up to 50 grams per day (about half a cup) of gluten-free dry rolled oats without any problems.

However, there is one crucial caveat: a small subset of people with celiac disease will actually react to a protein found in pure oats, known as avenin, just as if they were reacting to gluten. While it’s not known how many with celiac disease react to avenin, it’s generally accepted that it’s a small minority. According to the University of Chicago’s Celiac Disease Center, “perhaps fewer than 1 percent of celiac patients show a reaction to a large amount of oats in their diets.”

Unfortunately, there is not yet any clinical test to determine who will react to oats and who will not, so if a decision is made to incorporate oats into the gluten-free diet, there are precautions to follow. Melinda Dennis, a registered dietitian and the nutrition coordinator at the Celiac Center at Beth Israel Deaconess Medical Center in Boston, notes that before anyone adds oats to their gluten-free diet, this should be discussed with a dietitian or doctor. She also stresses only eating the proper kind of oats: “They must be pure, uncontaminated, gluten-free oats, specifically labeled as such.”

The newly diagnosed must ensure they are properly following the gluten-free diet, with all symptoms resolved and blood tests showing normal levels of antibodies associated with celiac disease. Then, the addition of oats should occur gradually, with lots of water intake, while informing the doctor of any symptoms. After three to six months, it’s important to follow up with a gastroenterologist.

The increased fiber intake from oats can also result in temporary gastrointestinal symptoms like bloating and gas – which can be confused with celiac symptoms. This is another reason why it’s important to incorporate oats into the diet gradually, and in concert with the advice of a dietitian or doctor. Adding pure oats to the gluten-free diet can be a boon to nutrition. Dennis says the grain is a good source of fiber, protein and B vitamins, and can also help to lower cholesterol levels. But beyond the nutritional benefit, being able to cook with oats increases the diversity of the diet, which is always welcome to those avoiding gluten.

At the end of the day, it’s up to the individual to decide what’s right for his or her diet. Odds are, that no problems will occur from eating a small amount of gluten-free oats, and adding them to the diet can boost nutrition and expand meal options. However, if symptoms appear, or antibody levels rise, speak to your doctor. Keep in mind that there are the unlucky few who can’t even tolerate pure oats.

Medical research into finding a long-lasting food allergy treatment has just been given a huge shot in the arm. Billionaire tech mogul Sean Parker, the former president of Facebook, is donating $24 million to Dr. Kari Nadeau and her team at Stanford University.

The funds will be used to create the Sean N. Parker Center for Allergy Research, and to ramp up the scientific work of immunologist Nadeau and her team, as well as collaborators at other sites.

Parker and Nadeau have ambitious objectives. In a media conference call, they spoke of making “catalytic change” and moving toward a therapy that takes only one or two treatments, retrains the immune system at the cellular level – and lasts.

“The goal is really important to keep in mind,” said Parker. “It’s not just enough to come up with slightly better incremental improvements on the treatments that are out there, the goal is to achieve a cure.”

Parker, who famously started Napster before working with Mark Zuckerberg to make Facebook a global phenomenon, has a personal stake in seeking tech-style disruption in the world of allergy research. He’s at risk for anaphylaxis to several foods, including peanuts, other legumes, nuts and shellfish. He has needed emergency hospital care for both anaphylaxis and asthma – “my wife claims it’s been 14 times since we’ve been dating (they met in 2010) and now married. So it dramatically affects your life and, if you have a comorbidity such as asthma, it’s a much more severe problem.”

Dr. Kari Nadeau

As the father of two young children (his son was born in early December), Parker is also highly aware of the genetic component of allergies. Referencing the breathing issues he’s had with asthma and seasonal allergies, and the risks from trace amounts of food allergens, Parker notes: “It would be incredible if nobody, including my children, ever had to go through this.”

Nadeau is definitely among the researchers on the forefront of finding a successful treatment for food allergy. The field began to move ahead with oral immunotherapy or OIT in which miniscule, then gradually increasing amounts of an allergen are fed to an allergic person with the goal of desensitizing to a single allergen.

But that therapy has not been without sometimes serious side effects and setbacks, such as a 2013 Johns Hopkins University long-term follow-up study that found a majority of patients who were supposed to be desensitized still having symptoms – sometimes serious ones.

This does not deter Nadeau, since her work has already moved beyond OIT on its own. “Oral immunotherapy alone is helpful in many patients, but it doesn’t work in everyone,” she said on the media call. Much of her success at Stanford in the past three years has focused on the combination therapy of anti-IgE medication (known by the brand Xolair) followed by OIT to treat up to five food allergies at once.

It appears the immunologist and the new research center are planning to move forward with new clinical trials as early as 2015. Although Nadeau can’t yet be specific, in a press release she says she views Parker’s gift “as the springboard to improve the lives of those adults and children with allergies through immunotherapy that goes beyond oral therapy.”

On the media conference call, she and Parker both stressed an intriguing fact about food allergy. “We know that there are some people out there who had food allergies when they were children but naturally lost those allergies,” said Nadeau. “So we know that the immune system can be turned off. It can become non-allergic. The big question is ‘how’? How can we do it?”

Her team will be looking for key biomarkers in those who are sensitized, and in those who become desensitized. “I think it’s going to take combination therapies, I think we have to be smart about collaborating (with other centers) – we need to collaborate and share data,” she says.

Parker speaks of a fascination with the workings of the immune system, and has also given generously to immune-based cancer research. Aside from expressing confidence in Nadeau’s abilities as a researcher and immunologist, he is impressed by the level of patient involvement at Stanford – the clinic has a waiting list of 1,500 would-be desensitization patients. For clinical trials, he notes, “patient recruitment is almost as challenging as the science itself.”

So will he join the trials at the center that will soon bear his name? “There are some things on the horizon that are very promising, and I’ll be the first in line to try them,” Parker said. “I’m confident enough, that I’m probably going to be one of the first people to enter those trials when they open.”